Author/Authors :
Huang, Chun-Ming Kaohsiung Medical University - Graduate Institute of Medicine, Kaohsiung Medical University Hospital - Department of Radiation Oncology, Taiwan , Huang, Ching-Wen Kaohsiung Medical University - Graduate Institute of Medicine, Kaohsiung Medical University Hospital - Department of Surgery, Taiwan , Huang, Ming-Yii Kaohsiung Medical University - Kaohsiung Medical University Hospital - Department of Radiation Oncology, Taiwan , Lin, Chih-Hung Kaohsiung Medical University - Kaohsiung Medical University Hospital - Department of Pathology, Taiwan , Chen, Chin-Fan Kaohsiung Medical University - College of Medicine, Kaohsiung Municipal Hsiao-Kang Hospital - Department of Emergency Medicine, Taiwan , Yeh, Yung-Sung Kaohsiung Medical University - College of Medicine, Graduate Institute of Clinical Medicine - Department of Emergency Medicine, Taiwan , Ma, Cheng-Jen Kaohsiung Medical University - Kaohsiung Medical University Hospital - Department of Surgery, Taiwan , Huang, Chih-Jen Kaohsiung Medical University - Kaohsiung Medical University Hospital - Department of Radiation Oncology, Taiwan , Wang, Jaw-Yuan Kaohsiung Medical University - College of Medicine, Cancer Center, Graduate Institute of Clinical Medicine, Kaohsiung Medical University Hospital - Department of Surgery, Department of Medical Genetics, Division of Gastrointestinal and General Surgery, Taiwan
Abstract :
Objective: To determine the role of lymph node metastases (ypN) and perineural invasion (PNI) in patients with locally advanced rectal cancer (LARC). Subjects and Methods: Eighty-eight LARC patients receiving preoperative chemoradiotherapy from April 2006 to November 2011 were enrolled in this study. Univariate and multivariate analyses were conducted to determine the association between clinicopathologic features and clinical outcome. Results: The presence of ypN (p = 0.011) and PNI (p = 0.032) was a significant adverse prognostic factor for disease-free survival (DFS). High histologic grade (p = 0.015), PNI+ (p = 0.043) and ypN+ (p = 0.041) were adverse prognostic factors for overall survival (OS). Positive PNI was significantly associated with a higher risk of distant failure (odds ratio = 6.09; 95% CI: 1.57–27.05; p = 0.008). Moreover, patients with a coexistence of ypN+ and PNI+ had the significantly worst DFS (p 0.001) and OS rates (p 0.001) compared with other phenotypes. Conclusions: The presence of either PNI or ypN was a significant prognostic factor for predicting poor survival rates in LARC patients, especially those with a coexistence of both factors. Accordingly, we recommend an intensive follow-up and therapeutic programs for LARC patients with simultaneous PNI+ and ypN+.
